Lidocaine Toxicity: Dose, Symptoms & Treatment

Instructor: Alexandra Unfried

Alexandra earned her master's degree in nursing education and is currently a hospital supervisor/administrator.

Lidocaine is used as an anesthetic. It is a numbing agent that prevents and treats pain during procedures. This lesson will discuss lidocaine toxicity including the dose, symptoms, and treatment.

Pre-Procedure Lidocaine

Carrie is getting ready for her laser treatment appointment for her stretch marks on her abdomen. She has been unable to reduce the size and presence of her stretch marks from when she was pregnant. Carrie was prescribed topical lidocaine cream to apply to her abdomen before the procedure, which is supposed to numb the area so the procedure is more comfortable. Last time Carrie used the lidocaine cream for her laser treatment, she felt it was not very effective. This time she is applying even more cream in hopes for a better outcome.

Lidocaine

Lidocaine, used as a topical anesthetic, numbs the area that it is applied to. This assists in preventing and treating pain during certain procedures. It also can be used on minor burns, scrapes, and insect bites to provide relief from pain or itching. Lidocaine can also be injected prior to surgeries or painful procedures to numb an area and prevent pain.

The doctor's prescription for Carrie tells her to apply a small dose of lidocaine cream to her abdomen where her stretch marks are located. A thin layer of cream is all that she is supposed to apply. It is important for Carrie to follow her doctor's orders and use the correct dose.

Lidocaine Doses

Lidocaine can be used during surgery or procedures by being injected into the skin. This numbs the area regionally where the procedure will be. The dosage is based on weight and given as a maximum of four milligrams per kilogram (4 mg/kg) with the dose not exceeding 300 mg.

Lidocaine for topical administration comes in different forms including gel, cream, spray, ointment, lotion, liquid, and a skin patch. Most dosing for children is done by weight. The correct lidocaine dose for adults depends on the procedure and body area.

  • Ointments: Maximum amount is five grams (six inches from a five percent ointment); can be applied three to four times a day
  • Skin patch: Use one to three patches up to twelve hours a day
  • Solution for sore mouth or throat: 15 milliliters every three hours no more than eight times a day
  • The smallest amount of lidocaine needed to produce the numbing or pain relieving effect should be used
  • Lidocaine should not be applied to large areas of the body at one time
  • No heat, bandages, or compresses should be applied to skin with lidocaine on it
  • Do not apply lidocaine to skin that is open or irritated

Carrie applied three times the amount of lidocaine on her abdomen over her stretch marks. She also applied cream beyond the stretch marks because she did not want to feel any radiating pain during her laser treatment. When she shows up for her appointment she is showing signs of confusion, hand tremors, and not seeing clearly.

Lidocaine Toxicity Symptoms

Using excessive amounts of lidocaine can result in serious side effects because the medication is absorbed through the skin and into the blood. Symptoms of lidocaine toxicity include:

  • Irregular heartbeat
  • Seizures
  • Drowsiness
  • Ringing in the ears
  • Double vision
  • Decreased heart rate
  • Weak, shallow, or slow breathing
  • Confusion
  • Tremors or shaking
  • Feeling hot or cold
  • Loss of consciousness
  • Decreased blood pressure

Carrie is clearly showing signs of lidocaine toxicity as she arrives for her laser treatment. Now the clinic needs to treat her symptoms.

Lidocaine Toxicity Treatment

Injected lidocaine toxicity is treated by addressing any signs of distress and maintaining an open and active airway. This is done by applying oxygen by nose or face mask, or with intubation if the person is in distress. The first step in treating topically-applied lidocaine toxicity is to recognize the event and wash off the lidocaine as quickly as possible.

Medications should be given for symptoms such as:

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